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Dheenadhayalan J, Imran A, Devendra A, Venkatramani H, Velmurugesan PS, Rajasekaran S, Sabapathy SR. Can locking plate fixation and free Vascularised fibular transfer with skin island achieve good functional outcome in the treatment of large bone defects of Tibia ? A study of 26 cases. Injury 2024:111465. [PMID: 38508984 DOI: 10.1016/j.injury.2024.111465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/02/2024] [Accepted: 02/25/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Despite the availability of multiple treatment options, management of tibial bone loss continues to be a challenge. Free vascularized fibula graft (FVFG) with a skin paddle offers better advantages over the other methods. We aimed to study the functional outcomes and QALY of patients with large tibial bone defects following FVFG with a locking plate in 26 patients. MATERIALS AND METHODS We analyzed 26 consecutive patients with large tibial bone defects treated by free vascularized fibular graft (FVFG) and stabilization using a long locking plate between 2009 and 2018. All were followed up for a mean period of 42 months (24 months to 120 months). Bony union, graft hypertrophy, and complications such as stress fracture and infections were assessed. Multivariate regression analysis was performed to identify any association between demographic factors, injury characteristics, treatment-related factors, and fibular hypertrophy. Additionally, The EQ-5D quality-of-life (QOL) indices were obtained using the SF-12 score to evaluate the patients' overall quality of life. RESULTS The mean age of the patients at the time of presentation was 36.26 yrs (range, 18-60 years). The cause of bone loss was open injury in 16 patients and infected nonunion in 10 patients. Complete union was achieved in 25 patients (96 %) without any requirement of additional surgical procedures. The mean union time of the graft was 4.04 months (range, 3-6 months). The mean fibular hypertrophy calculated by De Boer index was 0.61 %, 11 %, 28.24 % and 52.52 % at 3,6 months and 1 and 2 years respectively. Patients with metaphyseal bone loss have significant fibular hypertrophy. Participants in our study experienced a quality of life equivalent to 0.88 (range 0.79-0.99) of perfect health. CONCLUSIONS FVFG with skin paddle and LCP fixation for massive tibial bone loss achieved satisfactory outcome and QALY even in the challenging healthcare environment of South India, a developing country.It maintains alignment, promotes graft hypertrophy, and prevents stress fractures. LEVEL OF EVIDENCE Level 4 LEVEL OF CLINICAL CARE: Level I Tertiary trauma centre.
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Affiliation(s)
- Jayaramaraju Dheenadhayalan
- Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals Pvt., Coimbatore, Tamil Nadu, India.
| | - Asif Imran
- Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals Pvt., Coimbatore, Tamil Nadu, India
| | - Agraharam Devendra
- Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals Pvt., Coimbatore, Tamil Nadu, India
| | - Hari Venkatramani
- Department of Plastic, Hand and Reconstructive Surgery, Ganga Medical Centre & Hospitals, Coimbatore, Tamil Nadu, India
| | | | - Shanmuganathan Rajasekaran
- Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals Pvt., Coimbatore, Tamil Nadu, India
| | - Shanmuganathan Raja Sabapathy
- Department of Plastic, Hand and Reconstructive Surgery, Ganga Medical Centre & Hospitals, Coimbatore, Tamil Nadu, India
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Wang J, Liu M, Yang C, Pan Y, Ji S, Han N, Sun G. Biomaterials for bone defect repair: Types, mechanisms and effects. Int J Artif Organs 2024; 47:75-84. [PMID: 38166512 DOI: 10.1177/03913988231218884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
Bone defects or bone discontinuities caused by trauma, infection, tumours and other diseases have led to an increasing demand for bone grafts and biomaterials. Autologous bone grafts, bone grafts with vascular tips, anastomosed vascular bone grafts and autologous bone marrow components are all commonly used in clinical practice, while oversized bone defects require the use of bone tissue engineering-related biomaterials to repair bone defects and promote bone regeneration. Currently, inorganic components such as polysaccharides and bioceramics, as well as a variety of bioactive proteins, metal ions and stem cells can be loaded into hydrogels or 3D printed scaffold materials to achieve better therapeutic results. In this review, we provide an overview of the types of materials, applications, potential mechanisms and current developments in the repair of bone defects.
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Affiliation(s)
- Jiaming Wang
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Mingchong Liu
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Chensong Yang
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yutao Pan
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shengchao Ji
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ning Han
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Guixin Sun
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
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Minokawa S, Shibata Y, Shibata T, Kosaka H, Izaki T. Bone formation of the coracoid bone graft after the Bristow procedure assessed using three-dimensional computed tomography. J Orthop Sci 2023:S0949-2658(23)00324-X. [PMID: 38030446 DOI: 10.1016/j.jos.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/08/2023] [Accepted: 11/14/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND The Bristow procedure has been shown to be a reliable method to prevent recurrent anterior shoulder instability by compensating for glenoid bone loss and producing the sling effect. The degree of postoperative morphological change in the coracoid bone graft is speculated to influence glenohumeral joint stability; however, the details of these changes after the Bristow procedure remain unknown. This study was performed to quantify the postoperative change in the coracoid bone graft volume as assessed by three-dimensional computed tomography (3D-CT). METHODS The Bristow procedure was performed on 17 shoulders in 17 patients from August 2018 to January 2020. All patients were men, and their mean age at surgery was 17.9 years. The mean follow-up duration was 21.4 months. Within the first week after the operation (Time 0) and at the final follow-up, 3D-CT was used to determine the total coracoid bone graft volume. The clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) shoulder score, the University of California Los Angeles (UCLA) shoulder score, and the Western Ontario Shoulder Instability Index (WOSI). RESULTS The mean volume of the total coracoid bone graft was 1.26 ± 0.29 cm3 at Time 0 and 1.90 ± 0.36 cm3 at the final follow-up (p < 0.0001). The mean JOA score, UCLA score, and WOSI were significantly better at the final follow-up than preoperatively (p < 0.001). No postoperative infection, neurovascular injury, or recurrent instability of the glenohumeral joint occurred. CONCLUSIONS In the Bristow procedure, the volume of the total coracoid bone graft as shown by 3D-CT was significantly greater at the final follow-up than at Time 0, and bone formation of the coracoid bone graft was found after the Bristow procedure.
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Affiliation(s)
- So Minokawa
- Department of Orthopaedic Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino, Fukuoka 818-8502, Japan.
| | - Yozo Shibata
- Department of Orthopaedic Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino, Fukuoka 818-8502, Japan
| | - Terufumi Shibata
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Hidetomo Kosaka
- Department of Orthopaedic Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino, Fukuoka 818-8502, Japan
| | - Teruaki Izaki
- Department of Orthopaedic Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino, Fukuoka 818-8502, Japan
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Noorlander-Borgdorff MP, Giannakópoulos GF, Winters HAH, Botman M. The Pedicled Fibula Flap for Lower Limb Reconstruction. Strategies Trauma Limb Reconstr 2023; 18:186-193. [PMID: 38404565 PMCID: PMC10891355 DOI: 10.5005/jp-journals-10080-1600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/02/2024] [Indexed: 02/27/2024] Open
Abstract
The pedicled fibula flap is a reliable technique to treat large defects in the tibia. Despite increasing evidence of its efficacy and good long-term outcomes, a knowledge gap exists in its indications and technique. This instructional article presents a comprehensive overview of the indications, pre-operative planning, step-by-step surgery, and subsequent post-operative management. How to cite this article Noorlander-Borgdorff MP, Giannakópoulos GF, Winters HAH, et al. The Pedicled Fibula Flap for Lower Limb Reconstruction. Strategies Trauma Limb Reconstr 2023;18(3):186-193.
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Affiliation(s)
- Marieke P Noorlander-Borgdorff
- Department of Plastic, Reconstructive, and Hand Surgery, Amsterdam University Medical Centers, Amsterdam, Netherlands; Amsterdam Movement Sciences Research Institute, Amsterdam, Netherlands
| | | | - Henri AH Winters
- Department of Plastic, Reconstructive, and Hand Surgery, Amsterdam University Medical Centers, Amsterdam, Netherlands; Amsterdam Movement Sciences Research Institute, Amsterdam, Netherlands
| | - Matthijs Botman
- Department of Plastic, Reconstructive, and Hand Surgery, Amsterdam University Medical Centers, Amsterdam, Netherlands; Amsterdam Movement Sciences Research Institute, Amsterdam, Netherlands
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Voljc T, Schintler M, Vasilyeva A, Kamolz LP, Buerger H. Simultaneous Free Fibula and Anterolateral Thigh Flap in Lower Extremity Reconstruction Following Osteomyelitis in a Trauma Patient: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1206. [PMID: 37512018 PMCID: PMC10384821 DOI: 10.3390/medicina59071206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/12/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023]
Abstract
This case report focuses on a 17-year-old polytrauma patient who suffered a septic wound infection after an open reduction and internal fixation (ORIF) and soft tissue reconstruction with a pedicled flap, which led to a substantial bone and soft tissue defect of the lower leg. After thorough antibiotic treatment and after ensuring a non-septic wound, the defect was reconstructed using a contralateral free fibula flap designed as a flow through flap in a double loop manner to accommodate two fibular fragments and an ipsilateral ALT flap. Early weight bearing was initiated 11 days after the free flap transfer under external fixation, with full weight bearing achieved in 36 days with external fixation. After the removal of external fixation, full weight bearing was able to be reinitiated after 13 days, leading to the patient's return to normal activity 6 months after the bony reconstruction. This case presents an innovative approach to treating a complex defect, with the final decision on using two separate free flaps instead of a single osteofasciocutaneous free flap resulting in a good bony reconstruction and soft tissue coverage, and with the use of external fixation enabling early rehabilitation.
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Affiliation(s)
- Tadej Voljc
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, University Hospital Graz, 8036 Graz, Austria
| | - Michael Schintler
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, University Hospital Graz, 8036 Graz, Austria
| | - Anna Vasilyeva
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, University Hospital Graz, 8036 Graz, Austria
| | - Lars-Peter Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, University Hospital Graz, 8036 Graz, Austria
| | - Heinz Buerger
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, University Hospital Graz, 8036 Graz, Austria
- Division of Hand and Microsurgery, Private Hospital Maria Hilf, 9020 Klagenfurt am Woerthersee, Austria
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Keykhosravi E, Faravani E, Dehghani Dashtabi S, Emadzadeh M, Alamdaran SA, Aminzadeh B. Comparison of Ultrasonographic Findings between Patients with Tethered Cord Syndrome and Healthy Children. IRANIAN JOURNAL OF MEDICAL SCIENCES 2023; 48:130-136. [PMID: 36895465 PMCID: PMC9989241 DOI: 10.30476/ijms.2022.93848.2517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/26/2022] [Accepted: 03/23/2022] [Indexed: 03/11/2023]
Abstract
Background Tethered cord syndrome (TCS) is a type of occult spinal dysraphism, which necessitates early detection as an essential component of patient management in reducing complications. This study aimed to compare the findings of spinal cord ultrasonography between TCS patients and healthy individuals. Methods The current study is a case-control study of patients who were admitted to the Akbar and Ghaem Hospitals (Mashhad, Iran) in 2019. The study population comprised 30 children with TCS aged under two years old, and the control group included 34 healthy peers of the same age. The maximum distance of the spinal cord from the posterior canal wall was measured in millimeters using ultrasonography. Demographic and sonographic findings of each participant were recorded in checklists, which were then entered into SPSS software. P values less than 0.05 were considered statistically significant. Results The study included 30 children with TCS and 34 healthy individuals with a mean age of 7.67±6.39 months. TCS patients had a significantly shorter maximum distance of the spinal cord from the posterior wall of the spinal canal than the control group (1.75±0.62 mm vs. 2.79±0.76, P<0.001). After performing corrective surgery, the TCS patients indicated significant improvement in this interval (1.57±0.54 mm to 2.95±0.49 mm, respectively, P=0.001). Conclusion In comparison to children without TCS, the spinal cord was substantially closer to the posterior canal wall in TCS patients. However, these outcomes were improved significantly in patients after surgery.
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Affiliation(s)
- Ehsan Keykhosravi
- Department of Neurosurgery, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elham Faravani
- Department of Radiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Maryam Emadzadeh
- Clinical Research Development Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Ali Alamdaran
- Department of Radiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Behzad Aminzadeh
- Department of Radiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Ugaji S, Matsubara H, Aikawa T, Tsuchiya H. Efficacy of Temporary Intentional Leg Shortening and Deformation for Treatment of Massive Bone and Soft Tissue Defects in Three Patients. Strategies Trauma Limb Reconstr 2022; 17:195-201. [PMID: 36756292 PMCID: PMC9886035 DOI: 10.5005/jp-journals-10080-1567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 08/22/2022] [Indexed: 01/01/2023] Open
Abstract
Aim This study describes the intentional deformation and shortening of a limb using external fixation (EF) in three patients with post-traumatic injury tibial defects and to assess the outcomes. Case description Three patients with infected non-unions and massive bone and soft tissue defects who were treated with temporary intentional leg shortening and deformation using a Taylor Spatial Frame (TSF) EF were retrospectively reviewed. The alignment was restored by gradual deformity correction and lengthening after a 2-week interval. No additional surgical intervention was required for soft tissue reconstruction after primary skin closure. Skin closure and good bone alignment were achieved in all patients. The functional outcomes and bone outcomes were evaluated for all cases according to the Paley criteria modified by the Association for the Study and Application of Methods of Ilizarov. All patients showed excellent bone outcomes. Two patients achieved excellent functional outcomes and one had a good outcome. The patient with a good outcome was unable to descend the stairs comfortably. Conclusion This technique is suitable for treating massive bone and soft tissue defects and should be considered as a treatment option. How to cite this article Ugaji S, Matsubara H, Aikawa T, et al. Efficacy of Temporary Intentional Leg Shortening and Deformation for Treatment of Massive Bone and Soft Tissue Defects in Three Patients. Strategies Trauma Limb Reconstr 2022;17(3):195-201.
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Affiliation(s)
- Shuhei Ugaji
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Hidenori Matsubara
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Takao Aikawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
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